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FORMULIR PENDAFTARAN

“ RA MANARUL HUDA”

KAMALSIH, DS JEMASIH – KETANGGUNGAN – BREBES

1. Nama Anak Didik :........................................................................


a. Nama Lengkap :........................................................................
b. Nama Panggilan :........................................................................
2. Tempat dan Tanggal Lahir :........................................................................
3. Jenis Kelamin :........................................................................
4. Agama :........................................................................
5. Anak Ke :........................................................................
6. Nama Orang Tua/Wali :........................................................................
7. Pekerjaan Orang Tua/Wali :........................................................................
a. Ayah :........................................................................
b. Ibu :........................................................................
8. Alamat Orang Tua/Wali :........................................................................
a. Jalan :........................................................................
b. Desa/Keluarahan :........................................................................
c. Kecamatan :........................................................................
d. Kabupaten/Kota :........................................................................
e. Provinsi :........................................................................
9. Diterima di RA :........................................................................

Kamalasih,......................20....

Orang Tua/Wali Yang Menerima

.......................................... ..........................................

*Pendaftaran sambil membawa Foto copy Akte Kelahiran dan Foto copy Kartu keluarga

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